Dan Jackson | The Daily World The entrance to the Behavioral Health Resources building on 8th Street in Hoquiam.

By Sam LuvisiThe Daily World

Mental health workers at Behavioral Health Resources, Grays Harbor’s main provider of mental health and addiction recovery services, notified the agency Monday that they would go on strike for three days beginning Friday, March 14.

The financially troubled organization serves clients in Grays Harbor, Thurston and Mason counties. The labor problems with members of Service Employees International Union Healthcare Local 1199NW, exacerbate financial problems that have the agency focused on looking for ways to increase revenue and cut costs. If the agency can’t fix its problems, it could affect treatment for several hundred people on Grays Harbor every month, local health officials say.

The strike starts at 8 a.m. Friday, March 14, and ends at 7:59 a.m. Monday. Locally, it will affect offices in Elma, Hoqiuam and Grays Harbor Crisis Center.

BHR says it has a strike plan that means crisis and other essential services will continue. The agency said appointments for out-patient clients will be rescheduled and medications will be delivered to those who need daily care.

“A weekend strike is the least costly financially and least disruptive for our clients. As we are a charity in great financial stress serving the public’s mental health needs, this is our primary concern at this point. We look forward to returning to negotiations next week and hope to come to an agreement quickly so we can focus on the business of serving the 10,000 people who count on BHR and our incredible staff,” reads a statement from the agency.

The Thurston County-based provider currently has a 10-bed “crisis stabilization treatment unit” in Hoquiam with a crisis hotline and 24/7 ability to respond to people in crisis, and centers for adult and children services in both Hoquiam and Elma. It also serves as many as 700 people on the Harbor with outpatient services each month, according to Joan Brewster, director of County Public Health and Social Services.

The non-profit agency faces numerous financial struggles — mainly stemming from a decrease in monthly operating cash. Officials at BHR say there are several factors, including: a recent need for a massive technology overhaul, productivity issues, a problem with clients not coming to their appointments, an increase in fees for employee health benefits and an audit finding that requires BHR to repay the government for billings for which BHR was ineligible for compensation.

BHR’s Director of Community Relations, Alliea Phipps, calls the problems faced by BHR a “crisis situation.” She has been working to find donors to help with upgrades to BHR’s technology. The community — businesses and individuals — have been generous she said. She’s still looking for 17 new computers for Grays Harbor alone, but at one time they needed 40.

The impact of BHR’s struggles has reached even further, for instance: having to delay payroll by a day (although only one time thus far), and most recently to implement a different medical plan — beginning March 1 — that will increase out-of pocket expenses for employees, said BHR’s CEO John Masterson. Behavioral Health Resources pays 100 percent of health premiums, but Masterson said it cannot afford the additional increase of $35,000 a month due to an 18.9 percent increase in employee health benefits.

In the three counties the union workforce includes 96 fulltime, 52 part time and 32 on call staff members represented by the SEIU, the agency says.

The organization says it faces “the perfect storm” of unforeseen events that culminated in the losses.

One is that it has not been able to bill for the full limit of what its contract calls for.

“There is revenue available to us that we haven’t provided the services for,” Masterson said, adding about 60 percent of its operating costs are fee-for-service, the remaining 40 percent are cost-reimbursed, or fixed cost.

The effect of no-shows is something the center is looking into, especially for their locations on Grays Harbor, said Phipps. Recent cutbacks in public transportation and the reality that many mental health patients may not have their own vehicles or the funds for gas, may make it difficult for patients to come to their appointments, said Phipps. She added BHR’s data shows spikes in no-shows for appointments in the third and fourth weeks of the month.

“That’s when people run out of money and can’t get gas to come,” she said.

When a client doesn’t show up to an appointment the center still has to pay the therapist, but the center isn’t paid by the government agencies it contracts with, so for the center it means a lot of lost revenue, she said.

Phipps is currently working on finding funds to supply bus passes or gas cards for clients to see if that has an impact.

“That’s what we’re hoping,” she said, adding she is currently working with different agencies and writing grants specifically for transportation. “We’re hoping we can track these, and see if that will matter. … I know it does because patients tell us it does matter.”

Apart from no-shows, which the center admits is a fairly common problem in the mental health industry, Masterson said the problems are also likely due to inefficiencies either in operating systems or individual organizational skills for employees who can have large and busy caseloads.

He says the agency’s electronic health records are an example of where they have been able to make a change that has made things easier — but it happened to coincide with other financial strains at the wrong time.

“We anticipated the impacts of electronic health records. We didn’t anticipate the other things,” said Masterson.

Another of those unanticipated events was that the Thurston Mason Regional Support Network, which contractually manages BHR’s state and federal funding, said the agency had to repay more than $447,000 for billings on an audit conducted over a two-year period because the billings were deemed ineligible for compensation. Masterson said most of the unpaid services involved group outings, such as field trip-like events, that were found to not be medically necessary or properly documented in accordance with Medicaid restrictions, although “in many cases they were loved by clients.”

“Some were extended trips that turned out to be more of social activities, but couldn’t be justified as medical,” he said.

The Regional Support Network also implemented a change in its accounting process due to a new data system, causing BHR to receive payments after a 30-day period, instead of at the beginning.

The union contract expired April 1, 2013. Masterson said they last bargained on Jan. 31 in the presence of a federal mediator (at the request of the union), but BHR ended up declaring an impasse. The issues of contention include the employee health benefits plan and productivity standards.

Brewster said despite BHR’s financial situation, they are still performing on all aspects of their contract with Grays Harbor County.

” … They’ve not downgraded any services,” said Brewster, adding the agency has been a “fantastic partner” to work with since they stepped in to assist with the needs of Evergreen Counseling Center clients after its closure in 2007.

Brewster said the county is working closely with the organization to see how it can assist in a recovery — including a financial analysis of the contract and which parts may be inadequate.

“We’re doing whatever we can to help them become stable,” she said, adding that they are specifically looking at one area, fees for outpatient services. “… The costs (of providing the service) may be higher than what we’re reimbursing them with, so we’re looking at that.”

Brewster said a current struggle they have is looking to balance their needs for additional Behavioral Health Resources staff time that may be beneficial to the community, but also to meet requirements for their funding sources — the bulk of which comes from Medicaid and some state dollars.

“Medicaid comes with a lot of restrictions,” she said, adding there are many things she would like to add, like broader outreach in the community like working with schools, but such restrictions make it difficult.

Brewster said losing Behavioral Health Resources as a provider for the county would have a “terrible impact” on the community.

“They’re serving between six and seven-hundred people every single month … those people are very dependent on those services,” she said.

The county does contract with Sea Mar Community Health Center as well, but for much smaller outpatient and drug treatment and behavioral health operation.

“One thing that does is it gives a client choices,” said Brewster, adding that they also contract with Catholic Community Services for some needs as well.

However, such services are small in comparison to those contracted for with Behavioral Health Resources, and Brewster said the county relies on their services. “Losing BHR would be a huge blow to the community, and we don’t want to see that happen,” she said. “… We want to work with them to see if we can help create a circumstance in which they can be financially sound.”

As part of BHR’s campaign in asking the public to assist with their financial struggles, they have currently started a “Go Green 4 BHR!” campaign, in which they are asking local businesses and people to display a green shamrock (which can be printed off from their Facebook page), said Phipps. A number of local bakeries, including Bill’s XL Bakery in Aberdeen are offering a variety of green baked goods with proceeds going to BHR during the month of March.

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